HealthMedicine

Defect of interventricular septum. DMF for the fetus: causes, diagnosis and consequences

Defect of the interventricular septum (VSD) is an opening located in the wall, which serves to separate the cavities of the right and left ventricles.

General information

This condition leads to abnormal mixing (shunting) of the blood. In cardiological practice, such a defect is the most common congenital pathology of the heart. Critical states with VSD develop at a rate of twenty-one percent. Equally, the appearance of this defect is affected by children both male and female.

VSD in a fetus may be isolated (that is, the only existing anomaly in the body) or a part of complex defects (atresia of the triple valve, transposition of blood vessels, common arterial trunks, tetralogy of Fallot).

In some cases, the interventricular septum is absent completely, such a vice is called the only ventricle of the heart.

Clinic of the DMZHP

The symptomatology of an interventricular septal defect is often manifested in the first days or months after the birth of the baby.

The most frequent manifestations of vice are:

  • Shortness of breath;
  • Cyanosis of the skin (especially fingertips and lips);
  • Decreased appetite;
  • cardiopalmus;
  • Rapid fatigue;
  • Edema in the abdomen, feet and feet.

VSD at birth can occur asymptomatically, if the defect is small enough, and manifest only in later terms (six or more years). The symptomatology directly depends on the size of the blemish (aperture), however, doctors should be alert to the noises that are heard during auscultation.

DMF for the fetus: causes

Any congenital heart disease appears due to abnormalities in organ development in the early stages of embryogenesis. An important role in this case belongs to external environmental and genetic factors.

With VSD, the fetus has an opening between the left and right ventricles. The left ventricular muscular layer is more developed than in the right one, and therefore the blood enriched with oxygen from the left ventricular cavity penetrates into the right and mixes with oxygen-depleted blood. As a result, less oxygen enters the organs and tissues, which eventually leads to chronic oxygen starvation of the body (hypoxia). In turn, the presence of additional blood in the right ventricle entails its dilatation (expansion), myocardial hypertrophy and, as a consequence, the occurrence of cardiac right ventricular failure and pulmonary hypertension.

Risk factors

The exact causes of the occurrence of VSD in the fetus are unknown, but an important factor is the weighed heredity (that is, the presence of such a defect in the immediate family).

In addition, a huge role is played by the factors that are present during pregnancy:

  • Rubella. It is a viral disease. If during a real pregnancy (especially in the first trimester) a woman underwent rubella, the risk of various anomalies of internal organs (including DMF) in the fetus is very high.
  • Alcohol and some medicines. Taking such drugs and alcohol (especially in the first weeks of pregnancy) significantly increases the risk of developing various anomalies in the fetus.
  • Inadequate treatment of diabetes mellitus. Uncorrected glucose in a pregnant woman leads to fetal hyperglycemia, which in the end can lead to a variety of congenital anomalies.

Classification

There are several options for the location of the VAW:

  • Conoventricular, membranous, peremembranous VSD in the fetus. It is the most frequent location of the defect and accounts for about eighty percent of all such defects. A defect is found on the membranous part of the septum between the ventricles with a probable spread to the output, septal and entrance sections; Under the aortic valve and the tricuspid valve (its septal flap). Aneurysms often occur in the membranous part of the septum, which is followed by the subsequent closure (complete or partial) of the defect.
  • Trabecular, muscular DMF at the fetus. It is found in 15-20% of all such cases. The defect is surrounded by muscles completely and can be located in any part of the muscular part of the septum between the ventricles. There may be several such pathological holes. Most often, such JMF in a fetus closes spontaneously spontaneously.
  • Podlugochnye, podaternialnye, infundibular, vyrobnevye vestibular tract account for about 5% of all such cases. The defect under the valves (semilunar) of the exit or conical partitions of the septum is localized. Quite often this VSD due to prolapse of the right valve of the aorta is combined with aortic insufficiency;
  • Defects in the region of the pathway. An opening is located in the region of the entrance part of the septum, just below the area of attachment of the ventricular-atrial valves. Most pathology accompanies Down's syndrome.

The most common are single defects, but there are also multiple defects in the septum. VSD can participate in combined cardiac malformations, such as tetralogy of Fallot, transposition of blood vessels and others.

In accordance with the size, the following defects are distinguished:

  • Small (symptomatic not expressed);
  • Average (the clinic occurs in the first months after childbirth);
  • Large (more often decompensated, with bright symptoms, severe course and complications that can lead to death).

Complications of DMF

With a small defect size, clinical manifestations may not occur at all or holes may spontaneously close immediately after birth.

For larger defects, the following serious complications can occur:

  • Eisenmenger syndrome. It is characterized by the development of irreversible changes in the lungs as a result of pulmonary hypertension. A similar complication can develop in both small and older children. In a similar state, part of the blood moves from the right to the left ventricle through the opening in the septum, because due to myocardial hypertrophy of the right ventricle, it is "stronger" than the left. Therefore, to the organs and tissues blood falls, depleted in oxygen, and, as a consequence, develops chronic hypoxia, manifested as a cyanotic shade (cyanosis) of nail phalanges, lips and skin in general.
  • Heart failure.
  • Endocarditis.
  • Stroke. It can develop with large defects of the septum, due to the turbulent flow of blood. Possible formation of blood clots, which can then clog the blood vessels of the brain.
  • Other pathologies of the heart. There may be arrhythmias and pathologies of the valves.

DMF for the fetus: what to do?

Most often, such heart defects are found on the second planned ultrasound. But do not panic.

  • It is necessary to lead an ordinary way of life and not be nervous.
  • The attending physician should carefully observe the pregnant woman.
  • If the defect is detected during the second planned ultrasound, the doctor will recommend waiting for the third examination (at 30-34 weeks).
  • If the defect is found on the third ultrasound, another one is scheduled before delivery.
  • Small (for example, VSD 1 mm in the fetus), the apertures can be closed spontaneously before or after birth.
  • It may be necessary to consult a neonatologist and carry out Fetal EKHO.

Diagnostics

It is possible to suspect the presence of a defect with auscultation of the heart and examination of the child. However, in most cases, parents learn about the presence of such a defect before the birth of the baby, when carrying out planned ultrasound studies. Sufficiently large defects (for example, VSD 4 mm in the fetus) are revealed, as a rule, in the second or third trimester. Small ones can be detected already after birth by accident or when clinical symptoms appear.

The diagnosis of "JMP" a newborn or a child of an older age or an adult can be based on:

  • Complaints of the patient. This pathology is accompanied by shortness of breath, weakness, pain in the heart, pale skin.
  • Anamnesis of the disease (the time of the onset of the first symptoms and their connection with the stresses).
  • Anamnesis of life (weighed down heredity, mother's diseases during pregnancy and so on).
  • General examination (weight, height, age-matched development, skin tone and others).
  • Auscultation (noise) and percussion (widening the boundaries of the heart).
  • Blood and urine tests.
  • ECG data (signs of ventricular hypertrophy, conduction and rhythm disturbances).
  • Rengenologichesky research (the changed form of heart).
  • Vetriculography and angiography.
  • Echocardiography (i.e., ultrasound of the heart). This study allows you to determine the location and size of the defect, and for doplerometry (which can be done even in the prenatal period) - the volume and directivity of the blood through the hole (even if the APS - VSD in a fetus 2 mm in diameter).
  • Cardiac catheterization. That is, the introduction of the catheter and the determination with its help of pressure in the vessels and cavities of the heart. Accordingly, the decision is taken on the further tactics of the patient's management.
  • MRI. Assign in cases if Echo KG is not informative.

Treatment

When a woman has a VSD, the fetus has a wait-and-see tactic, since the defect may spontaneously close before birth or immediately after childbirth. Afterwards, if the diagnosis is kept, the management of such a patient is done by cardiologists.

If the defect does not disturb the blood circulation and the general condition of the patient, it is simply observed. At large holes that violate the quality of life, they decide to conduct the operation.

Surgical interventions for VSD can be of two types: paliative (limiting pulmonary blood flow in the presence of co-morbid vices) and radical (complete closure of the hole).

Methods of conducting operations:

  • Open heart (for example, tetralogy of Fallot).
  • Cardiac catheterization with a controlled overlap of the patch on the defect.

Prevention of an interventricular septal defect

Specific preventive measures of VSD in the fetus are not, however in order to prevent CHD, it is necessary:

  • Apply to the antenatal clinic for up to twelve weeks of pregnancy.
  • Regularly visit the LCD: once a month, the first three months, once every three weeks in the second trimester, and then once every ten days in the third.
  • Observe the regime and adhere to proper nutrition.
  • Limit the influence of harmful factors.
  • Avoid smoking and alcohol.
  • Take medication only as directed by your doctor.
  • To put an inoculation against a rubella at least six months before the planned onset of pregnancy.
  • With burdened heredity, carefully monitor the fetus for early detection of the UPU.

Forecast

For small fetal fetuses (2 mm or less), the prognosis is favorable, since such apertures often close spontaneously. In the presence of large defects, the prognosis depends on their location and the presence of a combination with other defects.

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